NATIONAL HEALTH MISSION

A REPORT ON

MONITORING OF IMPORTANT COMPONENTS OF

NATIONAL HEALTH MISSION PROGRAMME IMPLEMENTATION IN

KANPUR DEHAT,

SUBMITTED TO

MINISTRY OF HEALTH AND FAMILY WELFARE

GOVERNMENT OF

DR. SURESH SHARMA

MS. DEVANSHI KULSHRESHTHA

MS. ADITI SINGH

POPULATION RESEARCH CENTRE , INSTITUTE OF ECONOMIC GROWTH

UNIVERSITY ENCLAVE , 110007

AUGUST 2017 NHM Haryana PIP 2016-17: Faridabad PRC-IEG, Delhi

Contents List of Tables 3 List of Figures 4 List of Abbreviations 5 Acknowledgement 6 Executive Summary 7 Strengths 7

Weaknesses 7

Introduction 9 District Profile: Dehat 10 Health Profile: Kanpur Dehat 12 Facility-Wise Observations 26 Combined District Hospital 26

CHC 32

PHC Sarwankhera 37

SC Nariha 41

SC Sangsiapur 43

Conclusion 45 Recommendations 49

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List of Tables

Table 1: Census Data for Kanpur Dehat 10 Table 2: District information at a glance 11 Table 3: Health Profile of Kanpur Dehat 12 Table 4: Health Infrastructure in 12 Table 5: Human Resource in Kanpur Dehat District 13 Table 6: Details of ANC Registrations in Kanpur Dehat District 14 Table 7: ANC Progress in Kanpur Dehat District 15 Table 8: Delivery Indicators in Kanpur Dehat District 16 Table 9: Delivery Indicators in Kanpur Dehat District 16 Table 10: Details of JSY Payments in Kanpur Dehat District 17 Table 11: Status of JSY Payments in Kanpur Dehat District 17 Table 12: Maternal Death Review in Kanpur Dehat District 18 Table 13: Neonatal health indicators in Kanpur Dehat District 18 Table 14: Treatment of sick neonates in Kanpur Dehat District 19 Table 15: Causes of Death in Children aged 0-5 years 19 Table 16: Immunisation Progress in Kanpur Dehat District 20 Table 17: Immunisation Progress in Kanpur Dehat District 20 Table 18: RBSK Progress in District 21 Table 19: Details of Family Planning Process in Kanpur Dehat District 21 Table 20: Family Planning in Kanpur Dehat District 22 Table 21: Communicable Diseases in Kanpur Dehat District 23 Table 22: Details of Non-Communicable Diseases in Kanpur Dehat District 23 Table 23: AYUSH progress in Kanpur Dehat District 24 Table 24: Community Process in Kanpur Dehat District 24 Table 25: Quality in health care services in Kanpur Dehat District 25 Table 26: Service Delivery Indicators in SC Nariha 42 Table 27: Service Delivery Indicators in SC Sangsiapur 44

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List of Figures Figure 1: Combined District Hospital (CDH) 26 Figure 2: Waterlogging in front of CDH, Kanpur Dehat 27 Figure 3: Biomedical Waste Management in CDH, Kanpur Dehat 31 Figure 4: BMW disposal in CDH, Kanpur Dehat 32 Figure 5: CHC Pukhrayan 33 Figure 6: PHC Sarwankhera 37 Figure 7 SC Nariha 41 Figure 8: SC Sangsiapur 43

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List of Abbreviations

ANC Ante Natal Care MDR Maternal Death Review

ANM Auxiliary Nurse Midwife MMU Mobile Medical Unit

Ayurveda, Yoga & Naturopathy, Unani, Ministry of Health and Family AYUSH MoHFW Siddha and Homoeopathy Welfare BEMOC Basic Emergency Obstetric Care MOIC Medical Officer In- Charge

BMW Biomedical waste NBCC New Born Care Corner

BSU Blood Storage Unit NBSU New Born Stabilization Unit

NavjatShishu Suraksha CDMO Chief District Medical Officer NSSK Karyakram CHC Community Health Centre NSV No Scalpel Vasectomy

DH District Hospital OCP Oral Contraceptive Pill

DMPA Depot Medroxyprogesterone Acetate OPD Out Patient Department

DPM District Programme Manager OPV Oral Polio Vaccines

ECG Electrocardiography PIP Programme Implementation Plan

EMOC Emergency Obstetric Care PNC Post Natal Care

FRU First Referral Unit PPP Public Private Partnership

Health Management Information HMIS PRC Population Research Centre System Information, Education and Rashtriya Bal Suraksha IEC RBSK Communication Karyakram Infection Management and IMEP RCH Reproductive Child Health Environment Plan IPD In Patient Department RKS RogiKalyanSamiti

IUCD Intra Uterine Contraceptive Device RPR Rapid Plasma Reagin

IYCF Infant and Young Child Feeding SBA Skilled Birth Attendant

JSSK Janani Shishu Suraksha Karyakram SKS SwasthyaKalyanSamiti

JSY Janani Suraksha Yojana SN Staff Nurse

LHV Lady Health Visitor SNCU Special New Born Care Unit

LSAS Life Saving Anesthetic Skill TFR Total Fertility Rate

LT Laboratory Technician TT Tetanus Toxoid

M&E Monitoring and Evaluation VHND Village Health and Nutrition Day

MCTS Mother and Child Tracking System

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Acknowledgement The Monitoring and Evaluation of NHM PIP in Kanpur Dehat district of Uttar Pradesh was successfully completed due to the help and cooperation received from District NRHM Staff and support extended by officials from State Medical, Health and Family Welfare Department. We gratefully acknowledge the support from the Chief Medical Officer of Kanpur Dehat district. We speciallythank the District Nodal Officers, District Programme Manager (Kanpur Dehat) Mr. Amitabh and the Health Education Officers for their help. The M&E exercise heavily relies on the cooperation and enthusiasm of the health facility staff and we thank them for their active involvement during the monitoring visits in the districts. Last but not the least, credit goes to all the NRHM officials, ANMs, ASHAs and beneficiaries who spent their time and responded to the questions with enthusiasm

Dr. Suresh Sharma Ms. Devanshi Kulshreshtha Ms. Aditi Singh

August 2017 Population Research Centre Institute of Economic Growth Delhi

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Executive Summary

Strengths  CHC Pukhrayanachieved 100% immunisation at birth.  In PHC Sarwankhera,fumigation is regularly done. The facility has functional laundry, dietary and drug storage facilities also.  Nukkadnataks for awareness are often organised by the CMO office.  Information, Education and Communication posters were displayed properly at most of the health centres. The district hospital had a rich display of IEC for the various schemes.  The premises of most of the facilities visited were clean and hygienic. Bed covers for hospital beds and toilets were also clean and in good condition.  Diet provided under the JSY/JSSK scheme was good. Essential dietary items like milk and fruits were provided properly to the mothers.  The drug delivery system was functional with counters and most of the essential drugs were available in all public health facilities. Medical equipment like the BP instrument, stethoscope, sterilized delivery sets, weighing machine, and needle cutter and so on were available and functional. There was supply of pregnancy testing kits, urine albumin and sugar testing kit and OCPs in most of the facilities visited.

Weaknesses  The combined district hospital in Akbarpur facesseveral issues in the collection of BMW include ill-timed supply, bad quality of bins and polythene bags, low budget for BMW. Further, the road from the hospital to the temporary storage site of waste is broken, prohibiting transport by trolley. The bins are not adequately covered. Vermins or pests can easily enter them. Locked gates or barbed wire is not provided around the bin. In the immunisation room, it was seen that waste is not collected frequently.  In CDH Akbarpur, the seating available for OPD patients is inadequate. In the wards, benches besides patients’ beds are not available. This leads relative visiting patients to sit on the beds. Toilets in the general ward are in bad shape. Female ward is dimly lit. There is water seepage in the building. Construction of the facility also needs to be reinforced. Further, roads in front of the facility were waterlogged at the time of this visit.  CHC Pukhrayan does not have a Nutritional Rehabilitation Center. It does nothave a dedicated OT for labour. There is one general OT which is not centrally air conditioned,

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and runs two operations per day.While an increase in population prompted a shift of this centre from a PHC to a CHC, the infrastructure and resources were not expanded appropriately. Security guards are not present in the facility, causing lax security measures. Females working in the facility feel unsafe because of this.  While the CHC in Pukhrayan is a FRU, and carries out C-section deliveries, it does not have adequate staff in the OT. There is no dedicated staff nurse or sweeper.  The registration counter for OPD should ideally have three lines- male, female and disabled. But the CHC lacks adequate staff to carry this out.  Both the sub-centres visited did not have adequate funds available, causing the ANMs to make certain expenses from pocket.  The SCs visited also face shortage of essential drugs and supplies.  The SC at Nariha lacks IEC display.

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Introduction

The Ministry of Health and Family Welfare, Government of India has involved network of Population Research Centres for quality monitoring of Programme Implementation plan of National Health Mission in the states. For the year 2016-17, monitoring of PIP in various districts of Rajasthan, Haryana, Uttar Pradesh and Delhi is being carried out by the Population Research Centre at Institute of Economic Growth, Delhi. This monitoring report relates to Kanpur Dehat District where the monitoring was carried out in last week of August 2017. In the district besides the Chief Medical Officer’s Office, Combined District Hospital- Akbarpur, Community Health Centre Pukhrayan, Primary Health Centre Sarwankhera and Sub CentresNariha and Sangsiapur were visited. The staff in the facilities greatly assisted with the process of monitoring. During the monitoring,we interviewed women who had recently delivered. This report provides a review of key population, socio-economic, health and service delivery indicators of the Kanpur Dehat District. The report also deals with health infrastructure and human resource of the district and provides insights on MCH service delivery including JSSK and JSY schemes, Family Planning, ARSH, bio-medical waste management, referral transport, ASHA scheme, communicable, non-communicable diseases and status of HMIS and MCTS. This report is based on the interviews of CMO, District Health Officials, ANM and beneficiaries. Along with the team some district health official also visited various health facilities.

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District Profile: Kanpur Dehat In 1981, Kanpur district was divided into the two districts of Kanpur Nagar and Kanpur Dehat with a view to reduce the crowd in Kanpur Mahanagar. The district headquarters are in Akbarpur (Mati).

Total area of the district is 3021.0 Sq. Km. The rural area covers 2940.1 Sq. Km. and urban recorded 80.9 Sq. Km. There are 966 inhabited villages and 63 uninhabited villages in the district. Akbarpurtahsil has the highest number (267) of inhabited villages while Derapurtahsil has the lowest number (138) of inhabited villages. In urban area, there are 9 statutory Towns and 03 Census Towns. The percentage share of urban population in the district is 9.7 percent as against 22.3 percent of the population in urban areas of the state. District Kanpur Dehat ranks 54th in terms of population in the state. Kanpur Dehat district has population density of 595 persons per sq.km. which is less than the state average of 829 persons per sq. km. Decadal growth rate of the district (14.9) percent which is below than the state average 20.2 percent. Kanpur Dehat district ranks 64th in terms of sex ratio (865) which is lower than the state average of 912 females per thousand males. Kanpur Dehat district ranks 8th in literacy with 75.8 percent which is higher than the state average of 67.7 percent. There are 329,817 households in the district accounting for 1.0 percent of the total households in the state. The average size of households in the district is 5.4 persons.

Table 1: Census Data for Kanpur Dehat

Description Uttar Pradesh Kanpur Dehat Actual Population 199,812,341 1,796,184 Male 104,480,510 963,255

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Female 95,331,831 832,929 Population Growth 20.23% 14.89% Area(Km2) 240,928 3,021 Density/km2 829 595 Proportion to Uttar Pradesh Population 100 0.90% Sex Ratio 912 865 Child Sex Ratio 902 897 Literacy 67.68% 75.78 Male Literacy 77.28% 83.45 Female Literacy 57.18% 66.86 Total Child Population (0 -6 Age) 30,791,331 251,965 Male Population (0 -6 Age) 16,185,581 132,839 Female Population (0 -6 Age) 14,605,750 119,126

Source: Census 2011

Table 2: District information at a glance

No. of Blocks 10 No. of Villages 1032 Population (2011) 1795092 Literacy Rate 77.52 Sex Ratio 862 Child Sex Ratio 892 Density of Population 594

Source- DPMU Office, 2017

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Health Profile: Kanpur Dehat The NMR in the district is 41, while infant mortality is 65. Maternal mortality rate is 250. Table 3: Health Profile of Kanpur Dehat

Health Indicators Number Percentage/Ratio NMR 41 IMR 65 U5MR 94 MMR 250 TFR 2.5 Fully immunized children 37244 72.51 ANC Registration in the first trimester 12046 20.25 Full ANC 23303 39.18 Safe Deliveries(Institutional+SBA attended home deliveries) 24283 46.69 Institutional Deliveries 24283 46.69 No of women received PNC checkups within 48 hours 24283

Source- DPMU Office, 2017

Health Infrastructure The district has one district hospital functioning out of a government building. All of 6 CHCs and 31 PHCs are also working in government buildings. Out of the 223 SCs, 181 function out of government buildings. The district does not have mother & child care centers, medical college, skill lab, DEIC or Adolescent Friendly Health Clinics. Private facilities exist in the district, but are not that great.

There are 17 108 ambulances and 28 102 ambulances. Besides these, 2 ALS vehicles are also available.

Table 4: Health Infrastructure in Kanpur Dehat District

Health Facility Number available Govt. building Rented building/ Under const.

District hospital 1 1 0 CHC 6 6 0 PHC 31 31 0

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SC 223 181 42 Mother & Child Care Centers - -- - Medical College 0 0 0 Skill Labs 0 0 00 District Early Intervention Centre 0 0 0

Delivery Points 15 15 0 Source- DPMU Adolescent Friendly Health Clinic 0 0 0 Office, 2017 Transport Facility Number available Number 108 Ambulances 17 17 102 Ambulance 28 28 Human Referral Transport 0 0 Resourc ALS 2 2 e and Mobile Medical Units 0 0 Trainin gs The district has 4 sanctioned and 1 contractual MOs, while 3 of these positions remain vacant. There is only one gynaecologist in the district, with a vacancy for one position. 3 paediatricians, one regular and one contractual surgeon, 96 ANMs,1 Lab technician, 17 Data Entry Operators, 33 Staff Nurses (both at CHC and PHC) are also available in the district. No X-ray technician or LHV is available in the district.

There is a vacancy for 3 MOs, 1 gynaecologist, 3 paediatricians, 1 lab technician, 1 data entry operator.

Table 5: Human Resource in Kanpur Dehat District

Position Name Sanctioned Contractual Total Vacant

MO’s including specialists 4 1 3 Gynecologists 1 0 1 Pediatrician 3 0 3 Surgeon 1 1 0 LHV 0 0 0 ANM 96 96 0 Pharmacist - - - Lab technicians 1 0 1 X-ray technicians 0 0 0

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Data Entry Operators 17 16 1 Staff Nurse at CHC 33 33 0 Staff Nurse at PHC ANM at PHC 0 0 0 ANM at SC 0 0 0 Any other, please specify - - -

Source- DPMU Office, 2017

No training either on IUCD insertion, RTI/STI/HIV screening, FIMNCI, NSSK, SBA, BeMOC, MTP, Minilap/PPS or NSV was given to any health personnel in the last financial year.

MaternalHealth ANC Check-ups Antenatal Care (ANC) is useful in prevention, early recognition and treatment of pregnancy related ailments and general medical problems. Reproductive health counselling is also done in these sessions.

It is advised to register early for these medical services. In the last two financial years, the district has seen a steady increase in the number of women who get registered in the 1 st trimester. However, the services that should be extended to pregnant women post registration have been lacking. Not all women 3 ANC check-ups or received TT2, Booster or IFA. Further, only 4% of women detected with severe anaemia were treated institutionally. On a positive note, there has been a decline in cases of hypertension among women registered for ANC.

Janani Suraksha Yojana, the safe motherhood programme for encouraging institutional delivery among poor womenrequires completion of 3 ANC check-ups for payment of incentives. All women who registered for ANC also registered for JSY.

Table 6: Details of ANC Registrations in Kanpur Dehat District

Indicators 2016 -17 2015 -16 % 1st Trimester registration to Total ANC Registrations 34.8 31.5

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% JSY registration to Total ANC Registration 100 100 % Pregnant Woman received 3 ANC checkups to Total ANC Registrations 65.2 62.7 % Pregnant women received TT2 or Booster to Total ANC Registration 67.1 70.4 % Pregnant women given 100 IFA to Total ANC Registration 87.1 77.4 % Pregnant women having severe anemia (Hb<7) treated at institution to women having Hb level<11 3.9 14.2 % New cases detected at institution for hypertension to Total ANC Registrations 9.1 16.3

Source- HMIS Data

In the data made available from the DPMU office, while the details of women who completed 3 ANCs in each block were not available, it can be seen that all women who registered for ANC received TT1 or TT2. This is contrast with the district level data available from HMIS.

Table 7: ANC Progress in Kanpur Dehat District

Block ANC Registered 3 ANCs TT1 or TT2 Akbarpur 4915 4915 Amroudha 5308 5308 3877 3877 Jhinjhk 3885 3885 4524 4524 Malasa 4029 4029 Rajpur 4282 4282 6491 6491 Sandalpur 3736 3736 Sarwanhkera 4422 4422

Source- DPMU Office, 2017

Delivery Indicators Promotion of institutional delivery is pivotal in reducing maternal and child death. The delivery indicators in Kanpur Dehat district show that there has been an increase in the incidence of institutional deliveries in the last two financial years. At the same time, the incidence of C-sections in institutional deliveries have also grown.

The reliance on private institutions for delivery has grown in the last two financial years. However, it should be noted that more C-sections (as a percentage of total deliveries in facility) are reported in private facilities.

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Post-delivery care is majorly extended up to 48 hours of delivery. Check-ups between 48 hours and 14 days of delivery are rarer.

Sex ratio at birth increased from 883 in 2015-16 to 901 in 2016-17.

Table 8: Delivery Indicators in Kanpur Dehat District

Indicators 2016 -17 2015 -16 % SBA attended home deliveries to Total Reported Home Deliveries 2 2.3 % Institutional deliveries to Total Reported Deliveries 88 79.6 % Safe deliveries to Total Reported Deliveries 88.3 80 % Women discharged in less than 48 hours of delivery to Total Reported Deliveries at public institutions 68.8 48.4 % Institutional Deliveries to total ANC registration 45.2 43.3 % C -section deliveries (Public + Pvt.) to reported institutional (Public + Pvt.) deliveries 1.5 0.8 % C -sections conducted at public facilities to Deliveries conducted at public facilities 0.7 0.8 % C-sections conducted at Private facilities to Deliveries conducted at private facilities 7 % Deliveries conducted at Public Institutions to Total Institutional Deliveries 87 100 % Deliveries conducted at Private Institutions to Total Institutional Deliveries 13 0 % Women receiving post-partum check-up within 48 hours of delivery to Total Reported Deliveries 93.7 90.7 % Women getting Post -Partum Checkup between 48 hours and 14 days to Total Deliveries 57.9 51 % Total Reported Live Births to Total Deliveries 99.2 99.1 % Newborns weighed at birth to live birth 97.9 88.5 % Newborns having weight less than 2.5 kg to Newborns weighed at birth 5.8 8.3 % Newborns breast fed within 1 hour of birth to Total live birth 95.9 98.5 % newborns visited within 24hrs of home delivery to total reported home deliveries 56.2 37.4 Sex Ratio at birth (Female Live Births/ Male Births *1000) 901 883

Source- HMIS Data

Table 9: Delivery Indicators in Kanpur Dehat District

Home Deliveries Block/Health Facility Institutional Deliveries SBA assisted Non-SBA

District Combined Hospital, Akbarpur 5294 00 CHC Akbarpur 119 0 Amroudha 601 0 CHC Sikandra 1223 0 Derapur 1662 0 1751 0 Maitha 1165 0 Malasa 465 0 Rajpur 1063 0

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Rasoolabad 2697 0 Sandalpur 1082 0 PHC Sarwankhera 604 0 CHC Pukhraya 3016 0 CHC Gajner 299 0

Source- DPMU Office, 2017

Janani Suraksha Yojana (JSY) Not all women who delivered at public institutions received any JSY incentive. This is not surprising, given that all women who registered for ANC did not complete all 3 ANC check- ups.

The payments to ASHAs for institutional delivery is very low at 52%(or in case of 21 thousand deliveries), even if it has seen an increase from 2015-16.

Table 10: Details of JSY Payments in Kanpur Dehat District

Indicators 2016 -17 201 5-16 % Mothers paid JSY incentive for home deliveries to Total Reported Home Deliveries 0.1 0.1 % Mothers paid JSY Incentive for Delivery at Public institution to Total Public Deliveries 87.9 73 % of cases where JSY Incentive paid to ASHA for Delivery at Public institution to Total Public Deliveries 52.6 45.5

Source- HMIS Data

Table 11: Status of JSY Payments in Kanpur Dehat District

Status of payments for JSY

Institutional deliveries Home Deliveries Deliveries brought by ASHAs 21041 0 18077

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Source- DPMU Office, 2017 Maternal Deaths There have been 6 maternal deaths in Kanpur Dehat District in the previous year. 3 of these occurred in the hospital. 5 out these 6 deaths occurred due to haemorrhage, while one of these occurred due to sepsis.

Table 12: Maternal Death Review in Kanpur Dehat District

Total Maternal Place of Deaths Time of Death Major Reasons Deaths Hospital Home Transit During During Post Delivery pregnancy Delivery Hemorrhage 2 3

Obstetric

Complications

Sepsis 1

6 3 1 2 Hypertension

Abortion

Others

Source- DPMU Office, 2017

Adolescent &Child Health Neonatal Health

The infrastructure for child health in the district includes 2 NBSUs and 14 NBCCs. The SNCU has 8 staff nurses and NBSU has 3 staff nurses. There is one NRC with 8 staff positions.

While the district has a SNCU, it is non-functional owing to the lack of a paediatrician.

Table 13: Neonatal health indicators in Kanpur Dehat District

Numbers whether established in last financial year (Yes/No) Total SNCU 1 No (Non -functional due to vacant of Pediatrician)

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Total NBSU 2 Yes Total NBCC 14 Yes Total Staff in SNCU 8(SN) Total Staff in NBSU 3 (SN) Total NRCs 1 Total Admissions in NRCs 118 Total Staff in NRCs 8 Average duration of stay in NRCs 12

Source- DPMU Office, 2017

There were no admissions in the SNCU or NBSU in the previous year. There were 118 admissions in the NRC, with an average duration of stay being 12 days.

Table 14: Treatment of sick neonates in Kanpur Dehat District

Treatment Outcome Treatment Outcome Total Total neonates neonates admitted in Discharge Referred Death LAMA* admitted Discharge Referred Death LAMA* to SNCU in to NRCs

0 0 0 0 0 118 118 0 0 Source- DPMU Office, 2017

Childhood Diseases

The most prevalent reason for childhood death in both financial years was diarrhoea and dehydration. However, measles as a cause has caused more deaths in 2016-17 than in 2015-16. No cases of Diptheria, Pertusis, Tetanus Neonatorum (or Others) or Polio was reported in Children aged 0-5 Years.

Table 15: Causes of Death in Children aged 0-5 years

Cause of Death 2016 -17 2015 -16 Measles 1.7 0.2 Diarrhea and dehydration 97.8 98.4 Malaria 0.5 1.4 Source- HMIS Data

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Immunisation The administration of zero dose OPV and BCG at birth has grown in the last two financial years. Although the proportion of infants being vaccinated for measles has grown from the previous year, 10% of children drop out between the administration of BCG and measles. The administration of vitamin A presents a livelier picture as take-up is much higher. More children complete the 9 th dose than the first dose.

Table 16: Immunisation Progress in Kanpur Dehat District

2016 -17 2015 -16 % Newborns given OPV0 at birth to Reported live birth 84.8 72.8 % Newborns given BCG to Reported live birth 143.6 139.8 % Infants 0 to 11 months old who received Measles vaccine to reported live births 128.8 118.6 % Drop Out between BCG & Measles 10.3 15.2 % Children given Vit A dose1 to Reported live birth 128.8 118.6 % Children given Vitamin A Dose 9 to Children given Vit A dose1 207.1 156.3 % Immunisation Sessions Held to Immunisation Sessions Planned 95.1 94 % Immunisation Sessions where ASHAs were present to Immunisation Sessions Planned 89.3 88.9

Source- HMIS Data

Table 17: Immunisation Progress in Kanpur Dehat District

Full Block Target OPV at birth BCG DPT OPV Measles Immunizatio n Akbarpur 5290 4094 3896 3896 3782 68.64 Amroudha 5991 4685 4413 4413 4421 71.13 Derapur 4283 3284 3374 3374 3119 69.56 Jhinjhk 4184 3615 3219 3219 3263 74.43 Maitha 4863 4045 4587 4587 4447 87.83 Malasa 4333 3399 3234 3234 3274 72.02 Rajpur 4543 3871 3715 3715 3546 74.70 Rasulabad 7156 5334 5058 5058 4931 66.86 Sandalpur 3867 3038 2972 2972 2656 65.03 Sarwanhkera 4758 3890 3735 3735 3241 65.36 Pukhrayana 598 455 455 388 DCH 910 409 409 176

Source- DPMU Office, 2017

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Analysis of Block wise immunisation progress in the district reveals that Maitha district has come closest to meeting its immunisation goal (87%), while Sandalpur has performed the worst. (65.03%)

RashtriyaBal Suraksha Karyakram

RBSK team in the district covered 2456 school and registered 1.2 lakh children. Of these, 3871 children were diagnosed while 1747 were referred.

Table 18: RBSK Progress in District

Years No. of Schools No. of children registered Children Diagnosed No. of Children referred

2016 -17 2456 121875 3871 1747 2015 -16 Source- DPMU Office, 2017 Details of eye disease, ear, heart, physically challenged or anaemic children is not available,

Adolescent Health

Family Planning While there has been some growth in male sterilisations from the previous year, it is largely females who undergo sterilisation. Majority of these sterilisations were conducted in PHCs.

Laparoscopic sterilisations is the main process by which females undergo sterilisation. Post-partum sterilisation accounts for 1.5% of all female sterilisations. All sterilisations were done at public institutions.

Table 19: Details of Family Planning Process in Kanpur Dehat District

2016-17 2015-16 % Male Sterilisation (Vasectomies) to Total Sterilisation 1.7 0 % Total Sterilisation conducted at PHC to Total Sterilisation 63.8 50.3 % Total Sterilisation conducted at CHC to Total Sterilisation 27.4 37.3 % Total Sterilisation conducted at SDH/DH to Total Sterilisation 8.8 12.5 % Total Sterilisation conducted at Other Public Institutions to Total Sterilisation 0 0 % Total Sterilisation conducted at Private institutions to Total Sterilisation 0 0

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% Laparoscopic Sterilisations to Total Female Sterilisations 91 80.1 % Mini Lap Sterilisations to Total Female Sterilisations 7.5 16.7 % Post -PartumSterilisations to Total Female Sterilisations 1.5 3.2 % Laparoscopic Sterilisations at Public Institutions to Total Laparoscopic Sterilisations 100 100 % Mini Lap sterilizations at Public Institutions to Total Mini Lap Sterilisations 100 100 % Post -PartumSterilisations at Public Institutions to Total Post -Partum Sterilisation 100 100 % PP IUCD Insertions (public) to Total IUCD Insertions (public) 24.2 3 % PP IUCD Insertions (public) to Total Institutional Deliveries (public) 17.3 1.9 % IUCD insertions in public plus private institutions to all family planning methods (IUCD plus permanent) 95.1 92.7

Source- HMIS Data

The cases of sterilisation in all of the blocks falls way below their targets. Sarwankhera block achieved the highest level of IUCD insertions with respect to its set target, while Rasulabad block could only complete 20% of its IUCD target.

Table 20: Family Planning in Kanpur Dehat District

Block Sterilization IUCD insertions Oral Pills Condoms User Target Male Female Target Ach* Target Ach* Target Ach* Akbarpur 1035 4 63 3070 1653 1105 473 - 1017 Amroudha 1051 1 113 3124 745 1135 350 - 1324 Derapur 766 2 68 2300 1594 825 567 - 1121 Jhinjhk 839 0 17 2510 1559 905 288 - 1599 Maitha 909 1 60 2740 1705 986 416 - 1125 Malasa 812 4 82 2430 1528 875 385 - 1088 Rajpur 812 0 58 2430 986 875 461 - 1100 Rasulabad 1409 0 43 4220 863 1525 669 - 1260 Sandalpur 679 0 76 2040 1061 745 374 - 912 Sarwanhkera 939 1 88 2810 2087 1015 455 - 1064 Pukhrayana 0 0 25 0 269 0 28 - 59 DCH 0 0 57 0 1011 0 0 - 5

Source- DPMU Office, 2017 Communicable Diseases There has been a sharp rise in the number of detected cases of malaria in the district from 2015-16 to 2016-17, accompanied by a modest increase in the number of cases of TB. The number of detected cases of leprosy have remained more or less the same.

The data on Japanese Encephalitis or other communicable diseases is not available for the district.

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Table 21: Communicable Diseases in Kanpur Dehat District

2015-16 2016-17 Name of the Programme/ No. of No. of cases No. of cases No. of detected Disease screened screened detected cases cases TB 12635 1097 13999 1192

Leprosy 236 236 237 237

Malaria 44081 171 56867 405

Source- DPMU Office, 2017

Non- Communicable Diseases The data from DPMU Office reveals that there have been no screenings for diabetes, hypertension, osteoporosis, heart disease or other non-communicable diseases in the district.

Table 22: Details of Non-Communicable Diseases in Kanpur Dehat District

2014-15 2015-16 2016-17

Name of the No. of No. of No. of No. of cases No. of cases No. of cases Programme/ Disease detected detected detected screened screened screened cases cases cases

Diabetes 0 0 0 0 0

Hypertension 0 0 0 0 0

Osteoporosis 0 0 0 0 0

Heart Disease 0 0 0 0 0

Others, if any 0 0 0 0 0

Source- DPMU Office, 2017

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AYUSH Progress in District There is an AYUSH centre in each of the blocks in Akbarpur, Amroudha, Derapur, Jhinjhk, Maitha, Malasa, Rajpur, Rasulabad, Sandalpur, Sarwanhkera and Pukhrayana. There is one centre in the combined district hospital as well.

Table 23: AYUSH progress in Kanpur Dehat District

No. of facilities with No. of AYUSH Block AYUSH health centers Doctors

Akbarpur 1 1 Amroudha 1 1 Derapur 1 1 Jhinjhk 1 1 Maitha 1 1 Malasa 1 1 Rajpur 1 1 Rasulabad 1 1 Sandalpur 1 1 Sarwanhkera 1 1 Pukhrayana 1 2 DCH 1 2 Source- DPMU Office, 2017

The details of patients receiving treatment in the AYUSH centre is not known for any of the blocks.

Community Process in District 1700 ASHAs are presently working in the district. No ASHA resource centre or ASHA ghar is available in the district.

Table 24: Community Process in Kanpur Dehat District

Last status of ASHAs (Total number of ASHAs)

ASHAs presently working 1700

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Positions vacant

Total number of meeting with ASHA ( in a Year)

Total number of ASHA resource centers/ ASHA Ghar 0

Drug kit replenishment

No. of ASHAs trained in last year

Name of trainings received 1)

Source- DPMU Office, 2017

Quality in health care services

Bio medical pits are not available in any of the health facilities in the district. Provision of color coded bins and outsourcing of bio medical waste collection have been made available in the DH, all CHCs and 6 PHCs.

Table 25: Quality in health care services in Kanpur Dehat District

Bio-Medical Waste Management DH CHC PHC

No of facilities having bio-medical pits 0 0 0

No. of facilities having color coded bins 1 6 6

Outsourcing for bio-medical waste 1 6 6

If yes, name company MPCC MPCC MPCC

How many pits have been filled

Number of new pits required

Infection Control

No. of times fumigation is conducted in a year

Training of staff on infection control

Source- DPMU Office, 2017

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Facility-Wise Observations

Combined District Hospital

Figure 1: Combined District Hospital (CDH)

 The hospital looks at an OPD of 200 to 250 patients in a day, most dealing with ANC. Patients come from surrounding villages.  Local initiatives have not been that successful. NGO participation in healthcare in the district is low.

Infrastructure

 The female part of the combined district hospital functions out of 15 years old good condition building. The governing body is from the male hospital. The facility has The infrastructure in the facility is akin to a 30-bedded hospital. However, the facility has 60 donated beds.

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 Staff quarters for MOs are not available, while those for staff nurses and other categories are available. Further, rooms in the hospital for doctors are lower than what is needed.  The facility has electricity with power back up, running 24*7 water supply, clean toilets separate for male/female, clean labour room, with attached toilet and new born care corner. Daskh Skill Lab & ICTC Centre is available in the facility. BMW management process is in place.  The facility does not have NBSU, SNCU or ARSH clinic. Nutritional Rehabilitation Centre or Burn Unit are also not available. The blood bank is available with the male hospital.  The facility suffers from several drawbacks- seating for patients is inadequate. In the wards, benches besides patients’ beds are not available. This leads relative visiting patients to sit on the beds. Toilets in the general ward are in bad shape. Female ward is dimly lit. There is water seepage in the building. Construction of the facility also needs to be reinforced. Further, roads in front of the facility were waterlogged at the time of this visit.

Figure 2: Waterlogging in front of CDH, Kanpur Dehat

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NHM Haryana PIP 2016-17: Faridabad PRC-IEG, Delhi

8 ambulances- 4 108, 4 102, 2 ASLV

Human Resource

 The facility employs 2 regular OBGs, 2 regular Anaesthetist and 2 regular Paediatrician and One General Surgeon on contract. No Other Specialists are employed in the facility. 3 regular MOs, 7 regular and 8 contractual SNs, 2 contractual ANMs, 1 regular LT, Radiographer and Pharmacist. For Security of the facility, two home guards are employed.  The staff underwent training for SBA, MTP/MVA, NSSK, Mini Lap-Sterilisations, Laproscopy-Sterilisations, PPIUCD and Immunization and cold chain in the last fiscal year.

Equipment

 BP Instrument and Stethoscope, delivery sets, Neonatal, Paediatric and Adult Resuscitation kit, Weighing Machine (Adult and child), Needle Cutter, Radiant Warmer, Suction apparatus, Facility for Oxygen Administration, Foetal Doppler/CTG, Mobile light, Delivery Tables, Autoclave, ILR and Deep Freezer, Emergency Tray with emergency injections, MVA/ EVA Equipment and Phototherapy unit  Dialysis Equipment is not available. The facility also needs food trolley, larger capacity of RO and blood storage unit.  The facility has all OT equipment like O.T Tables, O.T lights (mobile & ceiling), Anaesthesia machines, Pulse-oximeters, Multi-para monitors, Surgical Diathermies, Laparoscopes and Autoclaves (H or V). Functional Ventilators or C-arm units are not available.  Laboratory Equipment like functional Microscope, Hemoglobinometer, Centrifuge, Semi autoanalyzer, Reagents and Testing Kits and Ultrasound Scanners. This is the only facility having ultrasound machine besides CHC Rasoolabad. C.T Scanner, X-ray units or ECG machines are not available.

Essential Drugs & Supplies

 The facility displays EDL and resorts to computerised inventory management.

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 Drugs such as IFA tablets, Vit A syrup, Inj Magnesium Sulphate, Inj Oxytocin, Misoprostol tablets, antibiotics. Labelled emergency tray is available.  Drugs for hypertension, Diabetes, common ailments e.g PCM, metronidazole, anti- allergic drugs etc and Adequate Vaccine Stock is available.  IFA syrup with dispenser, ORS packets, Zinc tablets and Mifepristone tablets are not available.  Supplies such as Pregnancy testing kits, Urine albumin and sugar testing kit, OCPs, EC pills or IUCDs are available. The facility does not have adequate supply of sanitary napkins.  Essential consumables such as Gloves, Mckintosh, Pads, bandages, and gauze etc. are available in the facility.

Laboratory Services

 The facility (pathology department in the male facility) can conduct tests for Haemoglobin, CBC, Urine albumin and sugar, Blood sugar, RPR, Malaria, T.B, HIV, Ultrasound scan (Ob.), Ultrasound Scan (General).X-ray& ECG is available in the male facility. Liver function tests(LFT) cannot be conducted at the facility.

Funds

 No funds were received by the health facility in 2016-17.

Maternal Health

 5294 deliveries were conducted in the facility in the previous year.  Anaemia is a common problem in pregnant women. While WIFS are distributed, their approach is mostly in the later stages of pregnancy and is not able to make as much of a difference as it could.  Mothers are asked to stay for 48 hrs after delivery.  JSSK diet is being provided free of charge. They receive milk and biscuits for breakfast, and thali for lunch. Food is made in the facility.  All mothers initiated breast feeding within one hour of normal delivery  Manage high risk pregnancy

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Child Health

 Zero dose BCG, Hepatitis B and OPV is given in the facility.  The facility has a new (6months old) SNCU. However, the space is not adequate as per its SNCU, and is affected by seepage.  Presently, no paediatrician is available in the facility. Children are referred to Kanshi Ram in Kanpur.  The facility can provide essential new-borncare (thermoregulation, breastfeeding and asepsis) and manage sick neonates and infants.

Adolescent Health

 No separate room for ARSH clinic is available.  Adoloscents come in via regular OPD. Irregular menstruation is themost common common problem.

ICTC

 Kits for RTI/STIare available in the ICTC room. 8-10 cases of HIV are reported per year.  Any high risk cases are individually screened and followed up.Pregnant women are also counselled. To tackle social stigma around these illnesses, family counselling is also done.  Saturdays are reserved for outreach in the community.  The centre also deals in family planning counselling

Blood Bank

 Blood storage capacity and amount of donations is low. Often, the supply for blood is lower than demand.  Functional blood bag refrigerators with chart for temperaturerecording and sufficient no. of blood bags are available.

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Biomedical Waste Management

Figure 3: Biomedical Waste Management in CDH, Kanpur Dehat

 The internal structure of BMW management in the facility involves a BMW committee (comprised of a doctor, a pharmacist, a supervisor, anaesthetist and a lady doctor) that meets monthly.  Waste collection has been outsourced to a company names MPCC. The contract for this arrangement is made on a district level. The rates for collection are mentioned in this the contract. No penalty clause is mentioned in this contract.  The issues faced in the collection of BMW include ill-timed supply, bad quality of bins and polythene bags, low budget for BMW. The hospital cannot make its own arrangements to manage BMW. While training for waste management is givento all staff, it is not working very well in all department. The best practice is followed in the OT, while its functioning in the labour room faces some issues.  The BMW supplies are collected by the pharmacist who is available only till 2pm. However, the delivery by the company is made at different hours. The company claims to collect more polythenes than it supplies.  The road from the hospital to the temporary storage site of waste is broken, prohibiting transport by trolley. The bins are not adequately covered. Vermins or pests can easily

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enter them. Locked gates or barbed wire is not provided around the bin. Handwashing facility is available close to the bins.

Figure 4: BMW disposal in CDH, Kanpur Dehat

 Blue bins are not available. Black bins are being used for this purpose.  In the immunisation room, it was seen that waste is not collected frequently.

CHC Pukhrayan

 The CHC in Pukhrayan is a FRU, and handles OPD of about 450 in a day.  Its catchment area includes a population of 28 thousand.

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NHM Haryana PIP 2016-17: Faridabad PRC-IEG, Delhi

Figure 5: CHC Pukhrayan

Infrastructure

 The health facility functions out of a government building and is in good condition.  Staff quarters for MOs, SNs and other categories are available.  The facility does not have a Nutritional Rehabilitation Center.  The development of a BB/BSU is underway.  There is no dedicated OT for labour. Thereis one general OT which is not centrally air conditioned, and runs two operations per day.  While an increase in population prompted a shift of this centre from a PHC to a CHC, the infrastructure and resources were not expanded appropriately.

Human Resource& Trainings

 The facility has one OBG (who is attached to the CHC in Rasoolabad) and one anaesthetist. Specialists for Ortho and ENT are employed in the facility, while no paediatrician or general surgeons are available. The facility has two medical officers, 7 staff nurses, 3 ANMs and 3 LTs. 4 pharmacists, 1 radiographer, 1 RMNCHA + counsellor and a ICTC counsellor also work at the facility.

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 Security guards are not present in the facility, causing lax security measures. Females working in the facility feel unsafe because of this.  The registration counter for OPD should ideally have three lines- male, female and disabled. But the facility lacks adequate staff to carry this out.  While the facility is a FRU, and carries out C-section deliveries, it does not have adequate staff in the OT. There is no dedicated staff nurse or sweeper.  The facility has 3 male sweepers as their contractual staff. It needs a lady sweeper for the labour room. Sweepers are also needed in the emergency OT 24*7.  The staff underwent training for Laparoscopy, PPIUCD and Blood storage in the previous financial year.

Equipment

 The facility has BP Instrument and Stethoscope, Sterilised delivery sets, Weighing Machine (Adult and child), Needle Cutter, Radiant Warmer, Suction apparatus, Facility for Oxygen Administration, Functional Autoclave and phototherapy unit.  Neonatal, Paediatric and Adult Resuscitation kits are available, but aren’t in a satisfactory condition  Functional ILR and Deep Freezer, Emergency Tray with emergency injections or MVA/ EVA Equipment is not available.

Essential Drugs and Supply

 While essential drugs list is displayed in the facility, it does not resort to a computerised inventory management.  Essential drugs and supplies are available at DHH except IFA syrup with dispenser, misoprostol and mifepristone tablets. The facility also does not have zinc, and has been facing a shortage of IFA with ANMs.  Vaccines are in stock. Laboratory Services

 The CHC has all laboratory equipment like Microscope, Hemoglobinometer, Centrifuge and Reagents and Testing Kits. It does not have a Semi autoanalyzer.

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NHM Haryana PIP 2016-17: Faridabad PRC-IEG, Delhi

 The facility can conduct tests such as Haemoglobin, Urine albumin and sugar, Blood sugar, RPR, Malaria, T.B and HIV. CBC and Liver function tests(LFT) are not done in the facility. Maternal Health

 The facility handles 300 deliveries in a month.  While the facility does C-sections, it does not conduct emergency C- sectionsasanaesthetist and surgeon are not available round the clock. In its catchment population, anaemia is not very prevalent. The need for C-section arises very ill- frequently. Further, the public has little inclination for C-section deliveries.  No maternal deaths were reported in this facility so far in this year.  JSY payments are up to date. Non-linkage of account number and or AADHAARhave led to some lapses in payments.  Iron sucrose is not available.

Child Health

 The facility has been conducting 100% immunisation at birth.  While it does not have a paediatrician, casesrelating to child health are managed by existing staff.  NBSS has two phototherapy units  There have been no neonatal or infant deaths in this year or the previous one.

Family Planning

 The facility conducts 1-2 sterilisations and mini-laps in a day.  PPIUCD is the most preferred mode of sterilisation. NSV procedures have been recently started. ECP takeup is relatively low,  Pressured by families  ICTC  Patients are followed up on. If positive, they are counselled. Sent to ART centre. RNTCP test is performed. Spose is tested. And the family is followed up on

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Funds

 Resources allocated are not sufficient per an individual facility’s need.  Funds are received by the facility under the RCH flexipool.

Drugs

 The facility faces a shortage of drugs.

Blood Storage Unit

 The facility has trained its doctors and LTs are trained, and will be applying for a license for BSU soon.

Community Process

 The performance of ASHAs is satisfactory.  As this facility is a non-block CHC, it is not directly involved in the community process.  ASHAs underwent 3 to 4 trainings in the last year.

Data portals

 MCTS data portal poses occasional problems for the facility.

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NHM Haryana PIP 2016-17: Faridabad PRC-IEG, Delhi

PHC Sarwankhera

Figure 6: PHC Sarwankhera

 The facility caters to a population of 1.6 thousand.  While OPD is only functional from 8 to 2, the facility runs 24*7.  Daily OPD for the facility is 400.  Seasonal diseases such as cold & skin diseases are common in the catchment area.  Agriculture is the prevalent occupation for the people in the facility’s catchment area.  The facility secured 2nd position in UP for Kayakalp.

Infrastructure

 Fumigation is regularly done in the facility. It has functional laundry, dietary and drug storage facilities also.

Human Resource

 The facility has limited staff compared to the OPD load it faces.  Among NHM staff, the facility has has 2 regular and 5 contractual MOs. 2 staff nurses. There are 26 ANMs in all (combining both regular and contractual positions). Besides

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this, the facility has 3 LHV/PHNs. Besides this, the facility has one dai and one chowkidar-cum-sweeper to assist the facility in day to day functioning.  The staff underwent training for SBA, NSS, IUD, RTI/STI and immunisation and cold chain in the previous year.  1 chowkidaar cum sweeper is also present in the facility.

Funds

 While the facility proposed for RKS funds amounting to 2.5 lakhs, it is yet to receive these.

Equipment

 BP Instrument and Stethoscope, Sterilised delivery sets, neonatal, Paediatric and Adult Resuscitation kit, Weighing Machine (Adult and infant/newborn), Needle Cutter, Radiant Warmer, Suction apparatus, Facility for Oxygen Administration, Autoclave, ILR and Deep Freezer, Deep Freezer, Emergency Tray with emergency injections and MVA/ EVA Equipment are available with the facility.  Laboratory Equipment like Microscope, Hemoglobinometer, Centrifuge, Semi autoanalyzer and Reagents and Testing Kits are also available with the facility.  Equipment repair mechanism is in place in the facility.

Essential Drugs and Supplies

 EDL is displayed in the facility premises and computerised inventory management is resorted to.  All essential drugs like IFA tablets, IFA syrup with dispenser, Vit A syrup, ORS packets, Zinc tablets, Inj Magnesium Sulphate, Inj Oxytocin, Misoprostol tablets, Mifepristone tablets, antibiotics, drugs for hypertension, diabetes and other common ailments are in adequate stock in the facility.  Labelled emergency tray and adequate Vaccine Stock are also available in the facility.  The facility has adequate stock of all essential supplies like pregnancy testing kits, urine albumin and sugar testing kit, OCPs, EC pills, IUCDs and Sanitary napkins and essential consumables such as Gloves, Mckintosh, Pads, bandages, and gauze etc.

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Laboratory Services

 The facility can conduct tests for Haemoglobin, Urine albumin and Sugar, Blood Sugar, Malaria, T.B, HIV, TLC, DLC and HBSDG.

Maternal Health

 The facility handles 36-40 ANC registrations in a day.  JSSK diet is provided in the facility.  2 beds have been provided in the female ward and 6 beds in the delivery ward. The facility handles two deliveries in a day.  Home deliveries in the facility’s catchment area have reduced considerably.  The facility is not capable of managing high risk pregnancies.

Child Health

 The facility can provide essential care to new-borns, and manage sick neonates and infants.Immunisation is carried out on Wednesday and Friday.  2 RBSK teams are functional in the district and are comprised of two doctors, 1 pharmacist and 2 ANMs. These teams usually identify cases of disability and skin infection. Adolescents encountered during these visits are encouraged to come to the clinic and are made aware of RTI/STI. Adolescentsoftencome in with problems of vision.

Adolescents Health

 Pads are distributed on the field. Sanitary napkins stock is available with the facility.  Problems often reported among adolescents are white discharge and RTI/STI.

Communicable Diseases

 3-4 check-ups for RNTCP are done per day. 10-11 positive cases are reported monthly.

Family Planning

 The catchment area of the facility faces lukewarm take-up for contraceptives.  Family size is 3 to 4 in the area.

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NHM Haryana PIP 2016-17: Faridabad PRC-IEG, Delhi

 PPIUCD is not done in this facility as most patients are anaemic and this increases chances of bleeding. Patients who experience bleeding are counselled.  Medicine or multiload is done in the facility.  It is difficult to convince the population for IUCD insertion.

Community Process

 Nukkadnataks for awareness are often organised by the CMO office.  The field team met with ASHAs-Sunaina Devi and SundaraDevi in the facility. The ASHAs conveyed that they face no problems relating to payments.  Weekly training of ASHAs and ANMs is undertaken in the facility.

Record Maintenance

 The following registers are maintained by the facility: OPD Register, IPD Register, ANC Register, PNC Register, Indoor bed head ticket, Line listing of severely anaemic pregnant women, Labour room register, OT Register, FP Register, Immunisation Register, Updated Microplan, Drug Stock Register, Referral Registers (In and Out) and Payments under JSY.

IEC Display

 Approach roads have directions to the health facility. Other IEC like Citizen Charter, Timings of the Health Facility, List of services available, Essential Drug List, Protocol Posters, JSSK entitlements, Immunization Schedule and JSY entitlements are displayed in the facility.

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SC Nariha

Figure 7 SC Nariha

 The health facility functions out of a government building whereelectricity or water are not available. While staff quarters are available, ANM does not reside there.  The facility is not a delivery point. Deliveries are referred to the DH.  The facility has one ANM, 7 MPWs and 7 ASHAs.No chowkidar is employed in the premises The ANM underwent 2-3 trainings in the last financial year.  It offers services such immunisation, IUCD, condoms and PPIUCD. Immunisation is carried out on Wednesday and Sunday. Sanitary napkins distributed as and when they are made available to the centre.  Among equipment, the sub-centre has a Hemoglobinometer, BP Instrument and Stethoscope, Adult weighing machine and Needle &Hub Cutter. It does not have an autoclave.  It faces some shortage of essential drugs and supplies. Misoprostol and IFA red has not been made available since May. The facility has Tetanus, iron and zinc, and these are made available to adolescents. Among medical supplies, the facility has stocks of urine

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NHM Haryana PIP 2016-17: Faridabad PRC-IEG, Delhi

albumin and sugar testing kits, EC pills, IUCDs and sanitary napkins. Occasionally, pregnancy testing kits are made available. Contraception methods such as condoms and oral pills are delivered by ASHAs.  There is no IEC display in the facility.  JSY payments not always made to ASHAs, delays in payments for kusht rog and DOTS  VCPM records maintained, immunisation, copper t and nirodh  VHND is done on Saturday and Wednesday  RBSK team comes, not much interaction with kids. That is done by Anganwadi workers  Untied funds untied have not been received for two years by the facility. Because of this, certain expenses, for example photocopying is done on personal expense.

Table 26: Service Delivery Indicators in SC Nariha

Service Utilization Parameter 2016

Number of estimated pregnancies 161

No. of pregnant women given IFA 50

Number of deliveries conducted at SC 0

Number of deliveries conducted at home 25

ANC1 registration 142

ANC3 coverage 161

No. of IUCD insertions 71

No. of children fully immunized 126

No. of children given Vitamin A 126

No. of children given IFA Syrup 0

No. of Maternal deaths recorded 0

No. of still birth recorded 2

Neonatal deaths recorded 0

Number of VHNDs attended 101

Number of VHNSC meeting attended 101

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SC Sangsiapur

Figure 8: SC Sangsiapur

 The facility is located inside school premises besides the Anganwadi centre. Electricity or water is not available in the facility. ANM quarters are present in the facility.  The facility (and the area) does not have adequate drainage.  One ANM and 5 ASHAs work at this facility.  While the facility does not have a hemoglobinometer, it has other methods of haemoglobin estimation, blood sugar testing kits, BP instrument and stethoscope, adult weighing machine and infant/new-born weighing machine.  It has adequate supplies of urine albumin and sugar testing kits, oral contraceptives, emergency contraceptives, IUCDs and condoms.  It offers services such immunisation, IUCD, condoms and PPIUCD. Immunisation is carried out on Wednesday and Sunday.  The facility faces a shortage of drugs.  During the interaction of the RBSK team with school kids, they are educated about hygiene and cleanliness.This is supplemented by the work of the anganwadi workers, who also distribute iron supplements.  ASHAs attached with this facility faced delays in payments for PPIUCD and JSY procedures.

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NHM Haryana PIP 2016-17: Faridabad PRC-IEG, Delhi

 IEC display was proper in the facility. Posters were made available fromthe CHC.  Untied funds are not available with the facility.Payments for certain expenses are made frompocket. Ambulance services are not available

Table 27: Service Delivery Indicators in SC Sangsiapur

Service Utilization Parameter 2016

Number of estimated pregnancies 165

No. of pregnant women given IFA 65

Number of deliveries conducted at SC 0

Number of deliveries conducted at home 17

ANC1 registration 165

ANC3 coverage 148

No. of IUCD insertions 69

No. of children fully immunized 121

No. of children given Vitamin A 121

No. of children given IFA Syrup 0

No. of Maternal deaths recorded 01

No. of still birth recorded 01

Neonatal deaths recorded 0

Number of VHNDs attended 84

Number of VHNSC meeting attended 84

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Conclusion Health Infrastructure

 The female part of the combined district hospital functions out of 15 years old good condition building. The governing body is from the male hospital. The facility has The infrastructure in the facility is akin to a 30-bedded hospital. However, the facility has 60 donated beds.  Staff quarters for MOs are not available, while those for staff nurses and other categories are available. Further, rooms in the hospital for doctors are lower than what is needed.  The facility has electricity with power back up, running 24*7 water supply, clean toilets separate for male/female, clean labour room, with attached toilet and new born care corner. Daskh Skill Lab & ICTC Centre is available in the facility. BMW management process is in place.  The facility does not have NBSU, SNCU or ARSH clinic. Nutritional Rehabilitation Centre or Burn Unit are also not available. The blood bank is available with the male hospital.  The facility suffers from several drawbacks- seating for patients is inadequate. In the wards, benches besides patients’ beds are not available. This leads relative visiting patients to sit on the beds. Toilets in the general ward are in bad shape. Female ward is dimly lit. There is water seepage in the building. Construction of the facility also needs to be reinforced. Further, roads in front of the facility were waterlogged at the time of this visit.

Human Resource and Trainings

 The district has 4 sanctioned and 1 contractual MOs, while 3 of these positions remain vacant. There is only one gynaecologist in the district, with a vacancy for one position. 3 paediatricians, one regular and one contractual surgeon, 96 ANMs, 1 Lab technician, 17 Data Entry Operators, 33 Staff Nurses (both at CHC and PHC) are also available in the district. No X-ray technician or LHV is available in the district.  There is a vacancy for 3 MOs, 1 gynaecologist, 3 paediatricians, 1 lab technician, 1 data entry operator.

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NHM Haryana PIP 2016-17: Faridabad PRC-IEG, Delhi

 No training either on IUCD insertion, RTI/STI/HIV screening, FIMNCI, NSSK, SBA, BeMOC, MTP, Minilap/PPS or NSV was given to any health personnel in the last financial year.

Maternal Health

 In the last two financial years, the district has seen a steady increase in the number of women who get registered in the 1st trimester. However, the services that should be extended to pregnant women post registration have been lacking. Not all women 3 ANC check-ups or received TT2, Booster or IFA. Further, only 4% of women detected with severe anaemia were treated institutionally. On a positive note, there has been a decline in cases of hypertension among women registered for ANC.  All women who registered for ANC also registered for JSY.  The delivery indicators in Kanpur Dehat district show that there has been an increase in the incidence of institutional deliveries in the last two financial years. At the same time, the incidence of C-sections in institutional deliveries have also grown.  The reliance on private institutions for delivery has grown in the last two financial years. However, it should be noted that more C-sections (as a percentage of total deliveries in facility) are reported in private facilities.  Post-delivery care is majorly extended up to 48 hours of delivery. Check-ups between 48 hours and 14 days of delivery are rarer.  Sex ratio at birth increased from 883 in 2015-16 to 901 in 2016-17.  Not all women who delivered at public institutions received any JSY incentive. This is not surprising, given that all women who registered for ANC did not complete all 3 ANC check-ups.  The payments to ASHAs for institutional delivery is very low at 52%(or in case of 21 thousand deliveries), even if it has seen an increase from 2015-16.  There have been 6 maternal deaths in Kanpur Dehat District in the previous year. 3 of these occurred in the hospital. 5 out these 6 deaths occurred due to haemorrhage, while one of these occurred due to sepsis.

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Child Health

 The infrastructure for child health in the district includes 2 NBSUs and 14 NBCCs. The SNCU has 8 staff nurses and NBSU has 3 staff nurses. There is one NRC with 8 staff positions.  While the district has a SNCU, it is non-functional owing to the lack of a paediatrician.  There were no admissions in the SNCU or NBSU in the previous year. There were 118 admissions in the NRC, with an average duration of stay being 12 days.  The most prevalent reason for childhood death in both financial years was diarrhoea and dehydration. However, measles as a cause has caused more deaths in 2016-17 than in 2015-16. No cases of Diptheria, Pertusis, Tetanus Neonatorum (or Others) or Polio was reported in Children aged 0-5 Years.  The administration of zero dose OPV and BCG at birth has grown in the last two financial years. Although the proportion of infants being vaccinated for measles has grown from the previous year, 10% of children drop out between the administration of BCG and measles. The administration of vitamin A presents a livelier picture as take-up is much higher. More children complete the 9th dose than the first dose.  Maitha district has come closest to meeting its immunisation goal (87%), while Sandalpur has performed the worst. (65.03%)  RBSK team in the district covered 2456 school and registered 1.2 lakh children. Of these, 3871 children were diagnosed while 1747 were referred.  Details of eye disease, ear, heart, physically challenged or anaemic children is not available,

Family Planning

 While there has been some growth in male sterilisations from the previous year, it is largely females who undergo sterilisation. Majority of these sterilisations were conducted in PHCs.  Laparoscopic sterilisations is the main process by which females undergo sterilisation. Post-partum sterilisation accounts for 1.5% of all female sterilisations. All sterilisations were done at public institutions.

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 The cases of sterilisation in all of the blocks falls way below their targets. Sarwankhera block achieved the highest level of IUCD insertions with respect to its set target, while Rasulabad block could only complete 20% of its IUCD target.

Communicable Diseases

 There has been a sharp rise in the number of detected cases of malaria in the district from 2015-16 to 2016-17, accompanied by a modest increase in the number of cases of TB. The number of detected cases of leprosy have remained more or less the same.  The data on Japanese Encephalitis or other communicable diseases is not available for the district.

Non- Communicable Diseases

 The data from DPMU Office reveals that there have been no screenings for diabetes, hypertension, osteoporosis, heart disease or other non-communicable diseases in the district.

AYUSH Progress in District

 There is an AYUSH centre in each of the blocks in Akbarpur, Amroudha, Derapur, Jhinjhk, Maitha, Malasa, Rajpur, Rasulabad, Sandalpur, Sarwanhkera and Pukhrayana. There is one centre in the combined district hospital as well.  The details of patients receiving treatment in the AYUSH centre is not known for any of the blocks.

Community Process in District

 1700 ASHAs are presently working in the district. No ASHA resource centre or ASHA ghar is available in the district.

Quality in health care services

 Bio medical pits are not available in any of the health facilities in the district. Provision of color coded bins and outsourcing of bio medical waste collection have been made available in the DH, all CHCs and 6 PHCs.

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NHM Haryana PIP 2016-17: Faridabad PRC-IEG, Delhi

Recommendations

 Drug prescription by doctors should be prescribed based on generic drug compositions. The onus of choosing which company should not lie with the doctors but on a medical board which can evaluate performance of companies. The capping should be placed on companies as to how much advertising is allowed.  Incentivefor sterilisation under JSY should be instituted to push the public towards sterilisation.  AYUSH doctors are involved with deliveries in some facilities.It may be worthwhile to explore the role AYUSH can play in maternal care. Complimentary AYUSH medicine could be some focus on JSY with AYUSH.  Infrastructure in the sub-centres needs to be improved so that adequate services can be delivered to the residents. Seating space for OPD patients and seating of visitors for IPD services should be provided in the facilities. Roads connecting health facilities should have mechanisms for drainage so that connectivity to the facility is not hampered. Several buildings were in need of repair or reinforcement, and this needs to be fixed.  Adequate human resources need to be hired in these health facilities so that service delivery is optimal.  The facilities face several issues in the collection of BMW, and these need to be addressed adequately. There is a need to sanction more funds for BMW. Quality of bins and polythene bags needs to be ensured. Problems faced by staff in transport of waste from facility to temporary storage site should be minimised. Locks or barbed wire should also be provided around the storage site.  On part of the facilities, it needs to be ensured that waste is regularly collected from the bins in the facility.

July, 2017 Page 49